Member Appeals Analyst

Job Summary

A company is looking for a Member Appeals & Grievance Analyst to join their team.

Key Responsibilities

• Documenting and investigating appeals, grievances, or complaints, including clinical care or reimbursement issues
• Notifying involved parties of review outcomes, including CMS and members, within regulatory timeframes
• Providing excellent customer service to members, providers, and CMS while adhering to regulations

Required Qualifications

• Associates degree or equivalent work experience required
• 2 years of customer service and/or claims experience
• 1 year of Medicare Advantage customer service and claims experience required
• Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint)
• Knowledge of CMS regulations and guidelines related to appeals, grievances, and complaints